influence of technological change on teaching and learning in the academy, The

Marion, Rodger

Education in the health care sciences is changing due to the increased use of technology. The use of computer-based technologies, among other technologies, has expanded rapidly. This expansion has changed not only the way in which health science education is delivered, but it is altering many fundamental structures in the academy. How the academy conducts research and provides service is being affected, in addition to ongoing changes in education. The objectives of this article are to review some of the technological trends affecting health care science education and to project those trends into the near future. Two models for making effective use of technological advancements in educational activity design and implementation are described. The changes brought on by the advance of technology not only affect how teaching is done but alter the ways in which future health care professionals will think and interact. Some illustrations of how these changes might be manifested are provided.

Key Words: Education, Futures, Health education, Instructional design, Internet, Learning, Teaching, Technology.


Once, I had a card to the British Library The British Library was not then, and is not now, open to the public. Only accredited scholars can obtain access. In the British Library is a hand-written copy of the Bible, called the Lindisfarne Gospels. This book, created in the eighth century CE, is both a faithful copy of the Old and New Testaments and an inspired and priceless work of art.1 This treasure of words and art has been preserved for over a millennium and is in impeccable condition. As a card-carrying intimate of the British Library, I could have requested access to this book and perhaps been allowed to examine it. This is the essence of traditional information. It is carefully preserved, and access is limited.

We have all seen the images of great medieval libraries, with monks toiling over illuminated copies of books, preserving ideas, and limiting their spread. In the British Library, there is also a copy of Gutenberg’s printed version of Jerome’s Vulgate, a Latin Bible. Printed somewhere around 1438 to 1455, this Bible was the great watershed in the availability of knowledge. Due to the technological advance of the printing press, there was no limit to the number of copies that could be made. The rebirth of knowledge in the Western world can be partially attributed to this miracle of production and distribution.

Today, we have the immediate availability of, apparently, any and all ideas, anywhere in the world and at any time. Here in the United States, there are no limits to Internet access, and I now can indeed look upon the pages of the Lindisfarne Gospels without asking anyone for permission.*

However, there is one catch to this electronic access. It is fleeting and dependent on the will of the owner of the content. I wrote a book, and for many years it was a text in my course. It was printed on paper, and there exist hundreds of copies. In recent years, I moved the book to an electronic format. It is now a series of Web pages, and anyone can look at it, at any time.[dagger] However, you the viewer do not own it, nor do you have a local copy of it (except for a temporary and anonymous one in your computer’s cache). In addition, I can revise the book at a moment’s notice or remove it completely at any time. Thus, in our electronic age, we have created a new, ethereal world of knowledge that is profoundly different from the knowledge systems of the past-open to everyone, but whimsical. These are elements that make the stoutest librarian quake in fear.

Knowledge and wisdom have been, and still are, controlled substances. In past times, the wisdom of the world was kept in monasteries and lamaseries where only trusted clerics were allowed to study the ideas and to talk of them.2 Now, in many countries of the world, computers and telephones are controlled to restrict access to the Internet. Ideas are still the harbinger of change, and change can be very scary. As educators, we are not necessarily scared that people may get the wrong ideas from the wide-open Internet or that they may not know how to use those ideas in their lives, but we are wary of how this may change our way of teaching.


On the surface, we are all technophiles. We embrace technology in our daily lives, buying the latest in televisions, stereos, cell phones, and computers. How many of us, however, shrug our shoulders at our inability to program a VCR? Let’s face it, we are apprehensive of the future and of change. We question whether new ways of doing things really are an improvement over the old. Many question how learning is affected by technology. Let’s discuss this aspect right at the beginning.

The use of technology does not appear to improve the levels of learning. Instead, technology affects the modes of learning. An early meta-analysis about the effects of using computer-based tools on learning held that computer-based teaching was equivalent to any other mode of instruction in terms of learning levels.3 The authors’ further asserted that the added value of computer-based activities lay in the realms of greater efficiency, improved access, and reduced cost. A brief scan of the last decade of the health care education literature seems to continue to support the claim that computer-based education produces the same learning results as any other medium4-9 and that its true benefits align closely with better meeting the needs of our changing academic environment. All things change, and we are going to be affected. So regardless of individual apprehensions, we in health care education are, in the narrow sense, committed to the use of computer-based communication and Internet data technologies, while in the larger sense, our whole world is evolving around us.

The use of technology in the academy embraces more than training students; it also includes expanding the horizons for research and service and for improved administration processes and communications. Briefly, the technologies involved are computers, networking, voice and data telecommunications, video, and two-way television. These technologies are used for many activities by educators: online courses, e-mail, conferencing, chat, virtual simulations, student-centered learning, online learning communities, remote mentor-learner relationships, online research collaboratories, online consumer support, and online administrative and management tools. How all of these technologies “come together” is defining a new way for the academy to “conduct business.”

The term “conduct business” is used not only as a metaphor, but to underline a shift in education where even public institutions are beginning to be operated, evaluated, and funded using modified business models. Like it or not, the public and legislators are beginning to look at education both as a process that is desirable to have and maintain and as a business to have the best return-on-investment possible. So we are faced with 2 revolutions in education: the rapid changes in our communication infrastructure due to adopting technology and changes in our funding and operations due to public demands for greater accountability and performance.

The use of technology in academic settings has grown very fast in the last decade; thus, the theoretical structures that provide models for the application of technology to the academic process are immature. Currently, this is an area of much speculation, experimentation, and trial. Three predictable stages of cultural adaptation characterize the integration and maturation of a major new technology such as the Internet. These stages are substitution, innovation, and transformation.10 Substitution describes the use of a new technology to replace an older one. As an example, the classroom lecture followed by a question-and-answer period can be replaced by a Web-based streaming lecture and followed up with an online discussion group.

Innovation is the development of a novel use for a new technology. The e-book is an example. This is a small, handheld, battery-powered device that has a high-resolution screen and is both a book and a note-taking device. Its utility lies in its ease of use. As opposed to trying to use a laptop computer in class, the e-book is as convenient as a textbook and a notepad.11 Another example is wireless network access. This technology lets students with laptop computers or handheld personal digital assistants access the Internet through the campus network. This any time, anywhere, access is changing how students communicate with each other and how instructors structure their classes. There is a shift away from lectures to more interactive classes where students seek answers via their links to the Web.12

Finally, transformation is the integration of the technology into society in such a way that it alters fundamental ways a society lives and does business. Basically, it is new ways of doing new things. The US President’s Information Technology/Advisory Committee has called for federal priorities to be set to address all elements of the technology-in-education equation: tools, systems, processes, learners, and teachers. They are asking for educators to push past the innovation level to the transformation level.13 Transformation is a total unknown at the present, but an example of what to expect comes from transportation. The worldwide adoption of the internal combustion engine during the first half of the 20th century changed the way we design cities and build roads and enabled the rise of suburbs and the development of shopping malls. American society was fundamentally changed from a rural agrarian society focused around small market towns to an urban/suburban society characterized by long-distance automobile and airplane travel.

Current futurists feel that several areas will prove fruitful in developing these new ways to do new and useful things. These are areas where new knowledge is needed. In the academy, these areas divide into 3 large categories.

First, the comprehensive integration of technology into academic pursuits creates new roles in academe. Unlike in earlier times, faculty are not sufficient to make optimum use of technology. The effective use of technology requires a team of specialists, with the faculty member as the content expert and a wide range of other professionals helping to make it all happen.14 This “new team”-its funding, design, training, and operation-is a major hurdle to surmount in order to make optimum use of technology in education. The instructor is both the “anchor” and the source of content. By “anchor,” think of the news reader on the evening television news. Somebody has to be the “person who teaches.” In the academy, faculty members both interact with students and provide the content. However, being the “person who teaches” is different in a Web-based course, and instructors need to learn both how to create a “virtual Web presence” for students and how to provide content when the library resources of the world are at your fingertips. No longer do instructors need to develop lectures that contain all the information needed by students. The Web is full of every sort of information, and instructors all over the world are placing more and more out there each day. Faculty now need to guide students to resources that are valid and reliable, rather than being the sole source of knowledge. This is so freeing a concept that it is difficult to grasp. As faculty, our new roles are to guide students to information, show them how to assess the value of information, and answer questions. Students now get to seek knowledge and to integrate it for themselves. We guide the process, but freed from the burden of being the priest, we can facilitate the movement of students to higher levels of learning and problem solving. For many of us, “getting out of the way” is a significant shift in behavior.

The remainder of the team brings technological and educational skills to the development process. The most important team member, after the instructor, is the instructional designer. This is a person who knows how to segment and organize information and learning experiences for implementation on the Web. The other team members are the graphics artist, videographer, programmer, information systems specialist, and network integration specialist. The first 3 team members work closely with the instructor and the instructional designer to visualize the materials (graphics, audio, and video) and to make it all work (programmer). The programmer works with the other 2 team members (information and network specialists) to develop places to store the Web elements and to deliver then via the Internet to students. Each of these roles is important and will not go away. In the long run, the notion of faculty developing Web sites is as unlikely as faculty setting type and printing their own books.

The second immature area is the design, development, and use of truly integrative computer-based activities into the learning process. We are just now moving into online models of traditional classroom instruction (two-way television, streaming lectures, PowerPoint[double dagger] slides on the Web), but there are new ways to create interactive and compelling learning that are undiscovered. The growth of the Web also has spurred the concept of distance education to new heights. Distance education used to be the home of “correspondence courses” and telephone conferences. Now everyone wants to offer courses to widely dispersed students, and the demand has been high. From early enthusiasm has emerged a certain concern about quality, and this is to be expected as these new distance education courses place unfamiliar demands on faculty. In addition, the ability to “stay closer” to students while on clinical rotations by using Web-based assignments and communication tools has changed the nature of this tradition of health science education.

There are many new possibilities and challenges. From these new challenges and the “new academic team” will come new solutions that will mix technologies and sciences in new ways. The innovative stage will develop a momentum that will spawn new ideas and new uses. This is called “synergy.” An example of synergy is the evolution of the jet engine from the internal-combustion engine that resulted in today’s super jetliners and international travel.

Third, in addition to the need for new models of learning, we need new models for research and academic collaboration. We need these models because modern technology is making our old models stumble.15 In today’s world, where we cannot solve the problem of how to send a big attachment with our e-mail, the development of a large center grant among several institutions, across multiple continents, using virtual planning conferences, multimedia-based proposals, and no paper, is a real challenge.

We can call education a “process,” and in doing so we broaden its implications to encompasses several areas of activity. In the most traditional context, the academy is where ideas are explored and students interact with masters. Beginning in ancient communities, the school has always had 2 roles: create knowledge and widen the circle of those who hold the knowledge. Modern schools have added a third component, that of service to the community. This third activity is based on using new knowledge to change the structures and processes of society. While “service” as an academic activity has been around for a long time and has taken many forms, an emerging model to integrate service with education is called “service learning.”16 This model seeks to provide methods for faculty and students to work with community health care providers to both practice clinical skills and train students in designing and managing projects that benefit the health status of the community. The emphasis is not so much on “doing” a service activity, but on learning how to be an effective agent of change and to provide professional role modeling. Thus, we see that there are trends to pull the academy into new settings and roles. Technology could be incorporated into community-based activities in a number of ways: (1) by providing communication links between the school and the community and between students in the field and students and faculty on campus, (2) by developing Web sites and other resources for patient education, (3) by sending live video images of patient care situations to distant students or faculty members (virtual grand rounds), (4) by providing an online database for patient information (virtual patient record), and (5) by others not yet imagined.

The academy is active in these 3 areas, and they are all intertwined. As students have become older and less traditional, old boundaries are being lost. Traditional roles are shifting. Are student expectations higher? Different at least? Can we separate where the school ends and the community begins? Does new knowledge develop from serving one’s fellows? Do students not teach the professor? The academy is many activities, but in summary, it is one enveloping process with a multitude of expressions. The 3 areas meld together, because without active and exciting service, research, and teaching, education cannot take place. Training can occur without all 3 elements, but education is a deeper concept and more than technical skills. The transformation period is coming, and it will give us new options for research, service, and teaching.

Currently, we are at the cusp of substitution and innovation. We have experimented with replacement and are seeking new innovations. To guide us through the process, we can make effective use of conceptual models.


To address a comprehensive model for the electronic university of the future is beyond our scope, but it is important to see that the technology we adopt in education is not an isolated process. The entire fabric of our academic society is evolving, and we need to be aware of these larger pictures. In modeling worlds, there are models inside of models. The concept of a socio-technological system includes technical systems, organizational systems, and other systems that interact to form the whole.17 Our focus is on a single model that is basically a technical system. It is a model for the design and development of Web-based instructional activities. It is used for developing Web-based materials and was derived from earlier work done by Marion and Niebuhr18 on simulation models for personal computers. This conceptual model has 2 diagrammatic parts, called “model A” and “model B.” The first diagram illustrates how to organize the content presentation and learning activities (model A), and the second model illustrates a structure for the programming process (model B). The programming model is as important as the structural model, because the medium of instruction influences the acceptance and processing of the content. Thus, how information is delivered is crucial. This concern is similar to the concepts raised in Marshall McLuhan’s famous saying, “The medium is the message.”19

For the last 3 years, my colleagues and I have been using models A and B as guides for developing Web sites. One site uses simulated patients and is designed to teach health care providers how to use telemedicine for referrals. This site is called the Worldwide Health Information System Simulation Linkage (WHISSL) and was developed with support from the US Bureau of Health Professions, Department of Health and Human Services. The other site is designed to provide examples of how to integrate complementary and alternative medicine (CAM) into traditional health care education. The site also includes patient cases and resources for CAM therapies. It is supported by the National Center for Complementary and Alternative Medicine of the National Institutes of Health.[sec] We have used the models to train faculty and the other team professionals and to guide teams in development work. The models have served well, and people like the metaphor they provide.

Model A

Model A provides 5 divisions of the content and activities. The 5 divisions are: knowledge, application, synthesis, scaffolding, and communication. The general relationships among the 5 divisions are shown in Figure 1.

The first 3 categories (the 3 boxes in the middle of the model shown in Figure 1) are used to organize the content presentation and learning activities and are based loosely on Bloom’s taxonomy of cognitive objectives.20 The top division, scaffolding, deals with the level of support and direction we give to the students as they work with the content. The bottom division, communication, represents the interaction that takes place between the students and the instructor and is made up of the several possible Web-based communications modes. This fifth division falls in the affective domain21 and includes motivational as well as interactive components. Each division is discussed in detail below. In addition, there are 2 Web sites available that illustrate the application of model A to an educational activity. The first Web site was designed as a simple application of model A to a Web-based learning task. The Web site deals with art appreciation, is quite simple, and illustrates the model clearly. The second example deals with trunk behavior during gait, is part of a professional course in physical therapy, and illustrates the model in a more real-world application than the first example.//

The knowledge division is where the majority of the content is presented. In Bloom’s taxonomy, the knowledge level is where information is presented to the learner and the learner is expected to recall the facts of the information. Thus, this part of the module will usually consist of either textual information or links to textual information. It could also include links to audio or video presentations. Assignments in this division are of the recall nature, such as a matching exercise between words and their definitions.

The application division is where students explore relationships between the facts that were presented in the knowledge division. This area usually takes the form of assignments where the students explore the relationships between facts and describe causal links. For example, in the trunk behavior module, students are asked to view a streaming video segment of a patient walking and to identify which muscle groups are active during each phase of the gait.

The synthesis division consists of mainly problem-solving activities because the synthesis level in Bloom’s taxonomy deals with the selection of information to be applied to a particular situation. An example of this form of activity comes from the trunk behavior module, where students view a streaming video file of a patient walking who has multiple injuries and then identify which muscle groups are affected by the injuries and how the multiple injuries interact to produce the gait seen.

The top division, scaffolding, relates to the balance between instructor-driven and student-driven learning. We want students to be independent learners, but while they are in school, they need guidance in the “how-to-learn” process. In the old teaching tradition, faculty relied on telling the students how to solve a problem. After explaining how to do it, we expected students to be able to do it themselves. The notion of problem-based learning often goes to the other extreme. Here, students are given problems and told to “go und solutions.” Either extreme leaves the students floundering. The instructor needs to find a balance between “providing guidance” and “setting them free.” This is where the concept of scaffolding comes into play. Scaffolding is the structure of support the instructor erects to assist the students in efficiently locating resources and tools to solve problems. Thus, a well-designed Web site can present students with a problem and, as they work through the problem, can provide gentle and appropriate guidance so the students have a successful learning experience and are still responsible for developing their own solution. A clever technological mechanism to use for this is the intelligent agent.22,23 One use of agents is as software processes that monitor the students’ behaviors, sense when they are going “off track,” and jump in at the right moment to give suggestions. You can see an agent in action at the WHISSL Web site by entering the Web site as a student.#

The bottom division, communication, allows the consideration of how the students and instructor will interact throughout the learning activity. Generally, Web-based communication can be illustrated by 3 classes of activities24:

* Interpersonal exchanges-people interacting over the Internet, sharing poems or essays, role playing, mentoring, providing support. These interactions can be done by e-mail, discussion forums (basically a common e-mail inbox that everyone can access), and real-time chat rooms.

* Information collections-creating a common database of information on the Internet by a widely scattered class of students.

* Collaborative problem solving-combines elements of the first 2 classes of activities into an interactive problem-solving activity.

These 3 classes of interaction are, in a sense, simulations of what goes on in a physical classroom. In the classroom, students discuss and practice with ideas and skills until they integrate them into useful tools and wisdom. In the online world, the most used communication modes are text, voice, pictures, and video. These 4 modes recreate being in a room with others. What about the physical aspect of the classroom? Can the Internet let students touch? Well, yes, it can. Using remote tools and sensors, students at one end (called the “far end”) can use an ophthalmoscope or ultrasound transponder and send that data to students at the “near end.” Thus, tactile elements can be done at a distance, and these elements, too, fit into the communication element of the model.

An instructional designer and the instructor use model A to structure the content and learning activities. Model B is used to translate the content and design into the Web pages.

Model B

Model B is the technical side of the instructional equation. It is as important as the first model. Model B has 3 divisions that each relate to a separate approach to Web page programming. The 3 divisions are: template, database, and handcrafted. Each division is described below. The functional relationships among the 3 divisions are shown in Figure 2.

Model B is a method for designing Web sites that utilizes every member of the development and teaching team who was discussed earlier. It facilitates the development of a Web site that is both easy to maintain and highly useful for the learner. The team can use model B to operationalize its plans for Web-based educational activities.

“Wait!” you say. “I’m a faculty member. I don’t care about the technical stuff.” As a faculty member, you need to understand how computer-based education is developed and structured, because the medium changes the message. You are not just translating classroom and laboratory experiences to a Web-based environment, you are transforming the content into new and different ways of presentation, interaction, and evaluation. Faculty must be aware of how the team works, how they interact with it, and how the team transmutes the content. Model B provides a framework for understanding how instructional Web sites are developed.

Before discussing how the 3 elements of model B work together, let’s look at the structure of a Web site. A Web page has 2 basic components. The first component is the content, and the second component is its layout-the graphical and typological elements of the physical Web page. One of the big problems with most Web sites is that each page is coded with layout and content as a single entity; a single file of computer code. Anytime the content changes, each page has to be edited. Additionally, to change any element of the layout, a font face or picture, every change must be coded into each page. This is a very high-maintenance process.

In model B, we separate the layout from the content. The layout is described in the template. The template is defined using cascading style sheets and HTML code held in files that are called into each individual page. Thus, a layout change can be coded by the programmer in one place, and it will appear on every Web page. The content is placed in databases, and it is accessed and laid out on the page using one of several server-side scripting languages (eg, Active Server Pages, Java Server Pages). Thus, the instructor can change the content in the databases using editing pages developed by the programmer. These 2 elements, template and database, result in a very low maintenance Web site, where the programmer can handle the coding and the instructor can handle the content. The programmer also can provide tools to enable the instructor to maintain the content by himself or herself.

Finally, the third element, handcrafted, is utilized. There are some Web-based features that cannot be fully handled by the template or stored in the database. These components, which include streaming videos, animations, and games, need to be handcrafted by the programmer, graphics artist, and videographer. There are some elements that cannot be made low maintenance. By doing as much as possible using the template and database, the few remaining elements can be hand coded, and the result is a cost-effective and efficient product.

There are tools, called “course management tools,” that have been developed by instructional designers and programmers to offer to faculty a fairly complete interface for developing and managing courses. These tools fit into model B by combining the template with the database, and they provide many useful resources (eg, grade book, discussion forums, chat rooms). These tools do not replace the new team, nor do they completely handle the development and delivery of an academic experience. The University of Texas TeleCampus has always used a course management tool for courses offered through its auspices. They discovered that faculty still required collaborators from the new team to be able to develop, manage, and revise online distance education courses.


Models for technology use in education have evolved over time. In the early days of computer-based learning, models based on concepts of “drill and practice” and “step-by-step concept learning” were popular. Many of us remember this as “programmed learning.”25 As computer tools have evolved, and especially since the creation of the graphically oriented Internet, we have taken to exploration-based learning strategies such as problem-based learning, simulations, and case-based learning.26 Our models of learning have evolved based on expectations of how people learn and how they want to learn.

We often do not know how people will use technology when first exposed to it. There are many factors that influence how a technology is used in society. Some of these factors are: visions of the inventors, repression by vested interests, unanticipated applications, adoption by social system builders, continuing efforts of the research and development community, resistance to change, and the users themselves.17 Often technology results in surprising new social patterns and expectations.27 To wit: “A recent survey has revealed that 80.5% of Oxford dons [faculty] seek out the likely pornographic potential on the Internet before making use of that facility for purposes connected with their own disciplines or research. The figure for students, in the same university, is 2% lower.”28 It is both disconcerting and valuable to know that people will use our educational materials and resources in ways we had not considered. This circumstance raises 3 points relevant to our models for computer-based education.

First, allow for people to do the unexpected with our materials and plan accordingly. This aspect is often evident when designing the user interface. For example, when designing a Web page element that allows a user to enter a word or phrase, we cannot assume that the person will then click on the button that says “Submit.” The person may instead press the “Enter” key to submit his or her entry. Another person, familiar with a spreadsheet, may press the “Tab” key to enter the information. For any request the program makes, there are many ways users may chose to respond.

Second, use the fact that people will seek out different or unusual paths through our materials and design accordingly. Recognizing that people will take novel paths through our materials really empowers us to make the materials varied, interesting, and captivating. Pilot testing of new materials can help to identify how people want to move through the material and to design multiple paths for users to select. In general, people like 2 things: (1) an overview of the whole process and (2) ways to “jump into” the process at multiple points. This caveat caters to the user’s need to see the whole picture to provide organization and establish expectations and the computer’s capability to provide random access. Computers excel at the nonlinear, and actually so do people. When you think about it, even our most ancient of instructional mediums, the book, is nonlinear and provides random access.

Third, people appear to be driven by curiosity first and practical concerns second. The early adopters of the Internet created the concept of “surfing the Web” and were for the most part people with backgrounds in technology and early computer aficionados.29 This group was driven by their interest in a novel experience and to see how far the technology was being pushed.30 The current wave of Web users are more concerned with achieving specific goals and use the Web to accomplish everyday activities easier, faster, or more cheaply.29 Thus, the implications for design of Web sites is a delicate balance between innovation and utility. Many portal sites are heavy with links to resources and options, but light on anything exciting or stimulating.** Many Web sites are functional and utilitarian, and that’s what users want. On the other hand, some Web sites are designed to be an experience, to capture the imagination.[dagger][dagger] The point here is to consider designing educational experiences that are both challenging to our creative instincts and resource rich, finding that balance between excitement and utility. A corollary is that the flash wears off, while the utility stays. An example of this phenomenon might be seen in the number of people who deactivate the animated paper clip that helps with using your word processor. The problem with utility, in the long run, is the onset of boredom. Thus, there is a need for the introduction of novelty at unexpected moments to delight the senses and rekindle interest.


William Gibson, the science fiction writer, has reportedly said, “The future is here. It’s just not widely distributed yet.” If this is true, then where is education going in the near future? O’Reilly31 suggests that technology can provide some cues to the future by looking at emerging technologies and extrapolating on the possibilities. He suggests 7 areas where big growth can be projected in the next few years: (1) wireless networks, (2) intelligent Web search engines, (3) weblogs (personal Web pages with databases), (4) instant messaging, (5) file sharing (distributed file storage and sharing by users, such as Napster[double dagger][double dagger]), (6) grid computing (distributed computers collaborating on elaborate computation tasks, such as SETI@home[sec][sec]), and (7) Web spidering (automatic gathering and integrating of information). Finally, I have added an eighth item, the smart card (a credit card-size card with an embedded processor, memory, and a short-distance wireless communication link so it can “talk” with other devices) to the list. These 8 technologies will contribute to a more integrated computing experience that focuses on empowering the individual. Below is a short story about a student in the near future pursuing her education with the latest tools and techniques.

Marian Sen is sitting at a picnic table under the spread of a giant banyan tree in Madagascar. She is a graduate physical therapist student at the State University of Texas (SUT). Her tiny, portable computer is solar powered, voice activated, and connected to the Internet by satellite. She has 4 tasks to do this morning before she returns for her afternoon shift at her clinical training site: (1) register for 3 courses for next semester, (2) finish a team patient consultation report, (3) ask her academic advisor to recommend her for a scholarship, and (4) review the data analysis results from her research project.

First, she logs onto the SUT Web site and selects the 3 courses she needs to take. Her request is submitted to universities around the world, and in few seconds she has a list of all the schools offering her courses. He decides to take one from Harvard University, one from her mentor at the University of Tasmania, and the third from SUT. She passes her smart card over the computer screen, and it automatically authorizes the transfer of her tuition and fees to each of the universities.

She and her teammates have been interviewing a patient on an oil drilling rig in the North Sea and working on a rehabilitation plan for him. Now she needs to write her part of the report. She accesses the weblogs of the interviews and looks at the video of the interview done by the speech therapy student again. As she is writing her report, she discovers the occupational therapy student did not place her electronic signature on the report. She queries her via instant messaging, and in a moment the needed signature pops up on the report. She finishes and signs her part and puts it back in the weblog to be accessed and graded later by her instructor.

She opens a stored query about scholarships and selects the one she wants. She passes her smart card over the screen again, and her demographic information is passed to the application and stored. She forwards the application to her advisor and appends a message asking him to write a recommendation for her.

She has been doing a study on the demographics of heart disease and rehabilitation in South America. To gather the data, she designed a spider query to search the national databases of all countries in South America and pull relevant data dealing with the incidence and severity of heart disease and data on rehabilitation outcomes. Then, to analyze the data, she set up a computing grid across a number of other students’ computers. The analysis is completed, and she looks at the three-dimensional models of incidence, severity, and rehabilitation outcomes. The results match closely with her hypotheses, and so we leave her, under the Southern sun, happily working on her research report.

This will happen sooner than you expect. Will we be ready to assimilate and integrate this kind of paradigm shift?


Models for the use of technology in education will abound in the coming years and will provide for integration. It is difficult to predict what these models will look like, but they will all integrate 3 concepts. Each will be digital, visual, and durable.

The electronic technology up until the 1960s was analog. Since then, our electronics and information have become more and more digital. Many mourned the passing of vinyl LP records and maintained that they sounded better, or at least were more authentic. But digital storage and processing has advanced until we can no longer separate the real world of limitless resolution from the finite world of digital representation. Negroponte26 has presented a compelling argument for this component of our digital future.

We are moving from a world of words to a future that is more visual. In the 19th century, words were the communication medium of choice. As we moved through the 20th century, the visual arts became dominant. The motion picture has more than eclipsed the book as a universal medium. Words must be translated to other languages to be available throughout the world. Movies, with and without subtitles, communicate at a universal level. As we move toward a more international society, the need to communicate clearly and efficiently continues to tip the scales toward reliance on clear and informative visual components. Tufte32 has illustrated the value and potential of visual explanation in the digital age.

How long does technology last? The technology frontier will have shifted by the time you read this article, and some of the innovations discussed here will be passe or just plain old hat. Some technology does last. There are turbines in hydroelectric dams that use the force of the water as bearing surfaces. These turbines have been producing power for nearly 100 years without ever being overhauled. The New England Confectionery Company has been using the same machines to produce Necco wafers candy// // since the 1880s. There is a project, called the Long Now Foundation, that is building a clock that is designed to run for 10,000 years. The idea is to design a machine that is so simple and durable that people in the future can understand its operation and maintenance simply by studying the mechanism, and thus keep it working forever.33

Can we bring the same durability to education? Will computer technology be a part of education in the same way machines have persisted? The educational horizon is changing, and we are moving along with it. In 10 years, much of what is now new will have matured and will have become much more elaborate and integral to our lives. Do you remember the rotary telephone and telephone numbers such as Klondike 5-1234? Many of us now use cell phones that integrate e-mail with voice. Some fairly remote places on earth have never had telephone lines, but now they have cell phones. Technology often “jumps” generations, because it is developed and evolves in one place, and then other places adopt it at a later stage. The future will be different, and we will adapt like it was always this way. The process of education is becoming more integrated. We will do research, service, and teaching in places we have never been and with people we have never met. We are entering a new experience brought to us by the technology we develop and guided by the models we construct. If we keep our technology elegantly simple and train our children to understand it at a conceptual, problem-solving level, we will achieve durability. Our technology will serve us and will evolve to serve new needs in new ways. As we look toward the future, what will be the lessons from the long now?

* You can see the Lindisfarne Gospels at these Web addresses: and

[dagger]The Web address of the Whole Art of Deduction is:

[double dagger]Microsoft Corp, One Microsoft Way, Redmond, WA 98052.

[sec]The URL for WHISSL is: The URL for the University of Texas Medical Branch is CAM Web site is:

//The URL for the art appreciation module is: The URL for trunk behavior during gait module is:

#To enter the WHISSL as a student, go to this Web site: As you begin to work through the simulated patient case, the WHISSL agent will appear, as needed, to offer guidance.

**Portals are Web sites that organize information into topics and provide access to many other sites (eg,,

[dagger][dagger]To sample a Web site that is pure experience, try this introduction to Zen practice at:

[double dagger][double dagger]Napster ( was the first major company to foster peer-to-peer sharing of files. The Web-based company ran into trouble with copyright law, but it is still an operational entity seeking to continue the peer-to-peer model of data sharing they pioneered.

[sec][sec]The Search for Extraterrestrial Intelligence (SETI) has established a grid computing scheme to analyze the vast amount of data collected by radio telescopes in its search for extraterrestrial intelligence. The idea behind SETI@home ( is to take advantage of the unused processing cycles of personal computers by asking users to install a program that runs in the background and downloads data, analyzes it, and then uploads it to the SETI server. This data analysis process goes on continuously, and the user can continue to use his or her computer.

// // New England Confectionary Co, 254 Massachusetts Ave, Cambridge, MA 02139.


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13. President’s Information Technology Advisory Committee (PITAC). Information Technology Research: Investing in Our Future. National Coordinating Office for Information Technology Research and Development; Arlington, Va: 1999. Available at:

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17. Hughes TP. Through a glass darkly: anticipating the future of technology-enabled education. EDUCAUSE. July/August 2001:16-26.

18. Marion R, Niebuhr BR. A general purpose algorithm for developing problem-solving simulations. Collegiate Microcomputer. 1986;4:331-338.

19. McLuhan HM, Fiore Q. The Medium Is the Message: An Inventory of Effects. New York, NY: Bantam; 1967.

20. Bloom BS, Engelhart MD, Furst EJ, et al. Taxonomy of Educational Objectives: The Classification of Educational Goals, Cognitive Domain. New York, NY: McKay; 1956.

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29. Long, PD. I have seen the Internet and it is us. Syllabus. 2001;15(3):10.

30. Kraut R, Patterson M, Lundmark V, et al. Internet paradox: a social technology that reduces social involvement and psychological well-being? Am Psychol. 1998;53:1017-1031.

31. O’Reilly T. The Shape of Things to Come. Keynote Lecture at the O’Reilly Emerging Technology Conference, Westin Santa Clara; Santa Clara, Calif; May 13-16, 2002. Available on the Internet as a white paper titled Inventing the Future by Tim O’Reilly at:

32. Tufte ER. Visual Explanations: Images and Quantities, Evidence and Narrative. New York, NY: Graphics Press; 1997.

33. Smith R. Lessons from the long now. Software Development. January 2000:20-26.

Rodger Marion, PhD

Dr Marion is Professor and Assistant Dean for Educational Technology, School of Allied Health Sciences, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-1028 (

Copyright Journal of Physical Therapy Education Winter 2002

Provided by ProQuest Information and Learning Company. All rights Reserved

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